A divided front in the abortion-rights movement

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Apr 03, 2023 View in browser   By Krista Mahr and Daniel Payne Presented by With help from Daniel Lippman Driving the Day Abortion-rights supporters don't agree on how far ballot initiatives should go. | Jim Salter/AP Photo IS RESTORING ROE ENOUGH? Internal divisions are splitting the abortion-rights movement over what limits — if any — to keep on abortion as ballot initiative efforts kick off in Missouri, Ohio, and South Dakota, Alice Miranda Ollstein and Megan Messerly report. What’s happening: The measures advancing in the states aim to restore the protections under Roe, which allowed states to restrict abortions later in pregnancy, usually after the fetus could survive outside the womb. But some say undoing the Supreme Court’s June ruling isn’t enough — and want ballot measures that bar any restrictions on abortion. Most involved agree that eliminating all abortion restrictions would be preferable but cite in-state polling and research to argue that measures with the viability standard have the best chance of passing. What’s at stake: The rift threatens to fracture the abortion-rights movement as it readies for costly ballot initiative fights likely to play central roles in coming state and federal elections. The divisions mirror those on the anti-abortion side as heated battles erupt in several states over whether to allow exceptions to abortion bans or hold firm to the view that abortion should be illegal no matter the circumstances that led to the pregnancy. On both sides, those pushing a compromise point to polls that show voters are overwhelmingly opposed to complete bans but support some limits — especially in conservative-leaning states. A 2022 Pew Research poll of more than 10,000 people found that abortion support waned as the pregnancy progressed: Americans are twice as likely to support abortion than say it should be illegal at six weeks, roughly split on whether it should be legal at 14 weeks and about twice as likely to say it should be illegal than legal after 24 weeks. WELCOME TO MONDAY PULSE — Happy National Public Health Week. If you’re still carrying some extra pandemic pounds, you’re in good company: New research found 10,000 active duty soldiers in the Army developed obesity during the health emergency, with similar trends in other military branches. Send your news and tips to kmahr@politico.com and dpayne@politico.com. TODAY ON OUR PULSE CHECK PODCAST, host Katherine Ellen Foley talks with Alice Miranda Ollstein, who reports on internal divisions that are splitting the abortion-rights movement over their efforts to keep abortion legal by putting it to a popular vote. Abortion-rights activists are clashing over what limits, if any, should be placed on ballot initiatives. Listen to today’s Pulse Check podcast   A message from PhRMA: What’s a pharmacy benefit manager (PBM)? They decide if medicines get covered and what people pay for them, regardless of what your doctor prescribes. These middlemen are putting their profits before your medicines. And getting between you and your doctor. You need to see what’s going on.   In Congress Sen. John Fetterman talked to CBS about his treatment for depression. | Michael M. Santiago/Getty Images FETTERMAN HEADS HOME — Six weeks after being hospitalized for depression, Sen. John Fetterman (D-Pa.) talked to CBS on Sunday about his struggle with mental health and his recovery as he prepared to leave Walter Reed to return home. “It’s like … you just won the biggest, you know, race in the country,” Fetterman said of his election in the fall. “And … the whole thing about depression is that objectively, you may have won. But depression can absolutely convince you that you actually lost. And that’s exactly what happened. That was the start of a downward spiral.” Fetterman’s doctor said the disease’s impact on the lawmaker — including a lack of motivation and his ability to think quickly and clearly — is “certainly reversible.”   JOIN POLITICO ON 4/5 FOR THE 2023 RECAST POWER LIST: America’s demographics and power dynamics are changing — and POLITICO is recasting how it covers the intersection of race, identity, politics and policy. Join us for a conversation on the themes of the 2023 Recast Power List that will examine America’s decision-making tables, who gets to sit at them, and the challenges that still need to be addressed. REGISTER HERE.     Want to receive this newsletter every weekday? Subscribe to POLITICO Pro. You’ll also receive daily policy news and other intelligence you need to act on the day’s biggest stories. At the Agencies A WIN FOR MEDICARE ADVANTAGE PLANS … FOR NOW — The Centers for Medicare and Medicaid Services finalized its payment rates to Medicare Advantage plans on Friday, agreeing to insurance industry demands to delay adjustments that will reduce their payments, POLITICO’s David Lim reports. Insurers will still get more money next year than CMS proposed in February. The agency expects the fiscal 2024 rate announcement to result in a 3.3 percent increase in payments to Medicare Advantage plans relative to fiscal 2023, compared with the 1 percent the agency proposed last month. But: A technical change to the risk-adjustment model used to calculate payments will phase in over three years, blunting the immediate impact on insurers’ bottom lines. TROUBLE AHEAD FOR OLDER AMERICANS? Social Security and Medicare face serious long-term financial issues, according to a new report released Friday by the programs’ trustees, POLITICO’s Erin Schumaker reports. The annual report comes out of a meeting of the Social Security and Medicare Boards of Trustees; the departments of Treasury, Health and Human Services and Labor; CMS; and the Social Security Administration. The trustees revised last year’s projections in light of more challenging economic forces, including persistent inflation and lower projections for gross domestic product and labor productivity. Why it matters: If nothing changes, older Americans could eventually see smaller retirement checks and lower payments to hospitals that treat Medicare patients. What’s next: The report urged lawmakers to consider options for each program, such as the proposal in President Joe Biden’s budget plan to increase Medicare taxes on Americans making more than $400,000 a year. Biden’s budget proposal would also allow Medicare to negotiate more prescription drug prices than is already laid out in the Inflation Reduction Act. While the proposals would extend Medicare’s life by at least 25 years, they're unlikely to gain bipartisan support in Congress.   A message from PhRMA:   Public Health ANOTHER POINT FOR BUPRENORPHINE — A new study finds that buprenorphine, a drug used to treat opioid use disorder, can be administered to patients who use fentanyl without triggering withdrawal — a widespread concern among many practitioners. The study, supported by the National Institute on Drug Abuse and published in JAMA Network Open, found less than 1 percent of patients using fentanyl experienced withdrawal symptoms when given buprenorphine in emergency rooms. Buprenorphine is also an opioid but less potent and has been shown to be effective in helping patients with opioid use disorder transition off more powerful drugs and stop overdose deaths. The study is part of an ongoing effort by the Biden administration to widen access to the life-saving drug as overdose deaths in the U.S. continue to soar. Doctors’ concerns that fentanyl-using patients might go into withdrawal have led some to prescribe lower doses of buprenorphine, which are less effective and increase the likelihood of patients using more dangerous drugs again.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     Names in the News Kathryn Brown is joining the Cystic Fibrosis Foundation as chief communications and marketing officer. Brown was most recently at Howard Hughes Medical Institute, where she served as chief of communications. What We're Reading A doctor who provides gender-affirming care writes in The New York Times about the wave of legislation in states limiting that treatment. New demands on pharmacists during the pandemic have led to worker burnout and staffing shortages, The Washington Post reports. To help treat suicide, we need to learn how to talk about it, The Wall Street Journal writes.   A message from PhRMA: Insurers and their PBMs don’t want you to see that you could be paying more than they are for your medicines. Rebates and discounts can significantly lower what insurers and PBMs pay for medicines. These savings can reduce the cost of some brand medicines by 50% or more. But insurers and PBMs aren’t required to share those savings with you at the pharmacy counter. They don’t want you to see that they use deductibles, coinsurance and other tactics to shift more costs on to you. Or that the three largest PBMs control 80% of the prescription drug market. Or that last year they blocked access to more than 1,150 medicines, including medicines that could have lowered costs for you at the pharmacy.  PBMs and insurance practices are shrouded in secrecy,  they need to be held accountable.       Follow us on Twitter Dan Goldberg @dancgoldberg Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Kelly Hooper @kelhoops Ben Leonard @_BenLeonard_ David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Megan R. Wilson @misswilson   Follow us

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